Provider Demographics
NPI:1063075612
Name:INDART, MARY CAITLIN (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CAITLIN
Last Name:INDART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 E ETIENNE WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1115
Mailing Address - Country:US
Mailing Address - Phone:208-989-9373
Mailing Address - Fax:
Practice Address - Street 1:5063 S COTTONWOOD ST STE 400
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6773
Practice Address - Country:US
Practice Address - Phone:801-507-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13352416-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology